New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:
Cost:
Service:: Change Lenses
prescribed by doctor:: Dr. Sadek Sadek
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1
OS	-1

Date of visit:: 3/15/2025 3:03:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metal + Anti-Blue Green Coated Lenses

	SPH	CYL	AX	ADD
OD	-1.75
OS	-1	-0.25	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS